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Tytuł:
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Impact of patient delay in a modern real world STEMI network.
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Autorzy:
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Fabris E; Cardiovascular Department, University of Trieste, Trieste, Italy. Electronic address: .
Arrigoni P; Cardiovascular Department, University of Trieste, Trieste, Italy.
Falco L; Cardiovascular Department, University of Trieste, Trieste, Italy.
Barbati G; Biostatistics Unit, Department of Medical Sciences, University of Trieste, Italy.
Stolfo D; Cardiovascular Department, University of Trieste, Trieste, Italy.
Peratoner A; Emergency Department, University of Trieste, Italy.
Vitrella G; Cardiovascular Department, University of Trieste, Trieste, Italy.
Rakar S; Cardiovascular Department, University of Trieste, Trieste, Italy.
Perkan A; Cardiovascular Department, University of Trieste, Trieste, Italy.
Sinagra G; Cardiovascular Department, University of Trieste, Trieste, Italy.
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Źródło:
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The American journal of emergency medicine [Am J Emerg Med] 2020 Jun; Vol. 38 (6), pp. 1195-1198. Date of Electronic Publication: 2020 Feb 19.
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Typ publikacji:
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Journal Article
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Język:
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English
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Imprint Name(s):
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Publication: 1983- : Philadelphia, PA : W B Saunders
Original Publication: [Philadelphia, PA. : Centrum Philadelphia, c1983]-
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MeSH Terms:
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Time Factors*
Percutaneous Coronary Intervention/*standards
ST Elevation Myocardial Infarction/*complications
Time-to-Treatment/*statistics & numerical data
Ventricular Dysfunction, Left/*etiology
Aged ; Analysis of Variance ; Female ; Humans ; Italy/epidemiology ; Male ; Middle Aged ; Percutaneous Coronary Intervention/methods ; Percutaneous Coronary Intervention/statistics & numerical data ; ST Elevation Myocardial Infarction/physiopathology ; ST Elevation Myocardial Infarction/therapy ; Ventricular Dysfunction, Left/epidemiology ; Ventricular Dysfunction, Left/prevention & control
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Contributed Indexing:
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Keywords: Myocardial infarction; Patient delay; Primary PCI; STEMI; System delay
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Entry Date(s):
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Date Created: 20200307 Date Completed: 20200824 Latest Revision: 20210611
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Update Code:
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20240105
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DOI:
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10.1016/j.ajem.2020.02.028
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PMID:
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32139214
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Background: The impact of patient delay on left ventricular ejection fraction (LVEF), when system delay has performance that meets the current recommended guidelines, is poorly investigated.
Methods: We evaluated a cohort of STEMI patients treated with primary percutaneous coronary intervention (pPCI) and with an ECG STEMI diagnosis to wire crossing time (ETW) ≤120 min. Independent predictors of pre-discharge decreased LVEF (≤45%) were analyzed.
Results: 490 STEMI patients with both ETW time ≤120 min and available pre-discharge LVEF were evaluated. Mean age was 64.2 ± 12 years, 76.2% were male, 19.5% were diabetics, 42.7% had and anterior myocardial infarction (MI), and 9.8% were in Killip class III-IV. Median time of patient's response to initial symptoms (patient delay) was 58,5 (IQR 30;157) minutes and median ETW time was 78 (IQR 62-95) minutes. 115 patients (23.4%) had pre-discharge LVEF ≤45%. At multivariable analysis independent predictors of decreased LVEF (≤45%) were anterior MI (OR 4,659, 95% CI 2,618-8,289, p < 0,001), Killip class (OR 1,449, 95% CI 1,090-1,928, p = 0,011) and patients delay above the median (OR 2,030, 95% CI 1,151-3.578, p = 0,014). These independent predictors were confirmed in patients with ETW time ≤90 min.
Conclusions: When system delay meets the recommended criteria for pPCI, patient delay becomes an independent predictor of pre-discharge LVEF. These findings provide further insights into the potential optimization of STEMI management and identify a target that needs to be improved, considering that still a significant proportion of patients continue to delay seeking medical care.
Competing Interests: Declaration of competing interest The authors report no relationships that could be construed as a conflict of interest.
(Copyright © 2020 Elsevier Inc. All rights reserved.)
Comment in: Am J Emerg Med. 2021 Jun;44:472-473. (PMID: 32690225)
